PULMONARY-FUNCTION AFTER TREATMENT FOR ACUTE LYMPHOBLASTIC-LEUKEMIA IN CHILDHOOD

The aim of this study was to examine pulmonary function after acute ly mphoblastic leukaemia in childhood and identity risk factors for reduc ed pulmonary function. We studied a population-based cohort of 94 surv ivors of acute lymphoblastic leukaemia in childhood who were in first remission after treatment without spinal irradiation or bone marrow tr ansplantation. Pulmonary function test results were compared with refe rence Values for our laboratory, based on 348 healthy subjects who had never smoked from a local population study. A median of 8 years after cessation of therapy (range 1-18 years) the participants had a slight , subclinical, restrictive ventilatory insufficiency and reduced trans fer factor and transfer coefficient. The changes in lung function were related to younger age at treatment and to more dose-intensive treatm ent protocols that specified more use of cranial irradiation and highe r cumulative doses of anthracyclines, cytosine arabinoside and intrave nous cyclophosphamide than previous protocols. We conclude that. 8 yea rs after treatment without bone marrow transplantation or spinal irrad iation, survivors of childhood acute lymphoblastic leukaemia in first remission were without pulmonary symptoms but had signs of slight rest rictive pulmonary disease including reduced transfer factor. The incre ased dose intensity of many recent protocols for childhood acute lymph oblastic leukaemia may lead to increased late pulmonary toxicity.